4 research outputs found
Review of Twin Pregnancies in a Tertiary Hospital in Abuja, Nigeria
Studies on twin pregnancy are uniquely important to Africa and
particularly Nigeria where the highest incidence in the world exists.
This study was designed to determine the trend, rate, and obstetric
outcomes of twin deliveries in the University of Abuja Teaching
Hospital, Gwagwalada. This was a retrospective study of twin deliveries
in the hospital over a period of 10 years. During the study period,
there were 349 twin births out of 10,739 deliveries, giving an overall
twining rate of 32.5 per 1,000 deliveries. Preterm delivery occurred in
39.7% cases and was, therefore, the most common complication. Mode of
delivery was vaginal in 72.7% while 27.3% were delivered by caesarean
section. Emergency caesarean section for delivery of both the babies
was carried out in 22.3% while elective caesarean section for both the
babies accounted for 1.0 %. Combined vaginal and abdominal delivery
occurred in 4.0% of deliveries. The stillbirth rate was 102 per 1,000
births. There were 24 (8.0%) and 37 (12.3%) stillbirths among the first
and the second baby respectively. The mean foetal weight was
2.395\ub10.63 kg while the female-to-male ratio was 1:1.1. The rate
of twin deliveries in our centre is high. Successful vaginal delivery
of twins is high when the mothers are booked and the presentations of
the twins are favourable. The use of antenatal care services and good
intrapartum management will help improve outcome in twin pregnancies
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial
Background
Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.
Methods
In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.
Findings
Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.
Interpretation
Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.
Funding
London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation
Traumatic Rupture of the Symphysis Pubis and Posterior Fracture Dislocation of the Femur Following Vaginal Delivery: A Case for Symphysiotomy
Mrs. I. M. was a 23 years old primipara referred to UBTH with traumatic rupture of the symphysis pubis and posterior fracture dislocation of the left femoral head, after a delay in the second stage of labour that lasted 3 hours and a crude manoeuvre to deliver the fetus. The baby suffered severe birth asphyxia and convulsive seizures three days postpartum.
She had a closed reduction of the hip joint dislocation and traction. Recovery was satisfactory. Considering this outcome, a properly timed symphysiotomy would have been a better option to the traumatic rupture of the symphysis pubis, if personnel with the appropriate skills were available.
(Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 38-39